Intimate Partner Violence and Modern Contraceptive Use among Married and Cohabiting Women in Malawi

<title>Abstract</title> <p>Intimate partner violence (IPV) remains one of the most pervasive violations of women’s human rights and a major public health challenge in sub-Saharan Africa. This study investigates the prevalence and socio-demographic determinants of IPV among married and cohabiting women in Malawi, and examines its association with modern contraceptive use using data from the 2024 Malawi Demographic and Health Survey (MDHS). The analysis is restricted to 3,954 women aged 15–49 years in union who completed the domestic violence module. Propensity score matching (PSM) was employed to estimate the effect of IPV on modern contraceptive use while addressing observable confounding. The overall 12-month prevalence of any IPV (emotional, physical, or sexual) was 32.8%. Prevalence was significantly higher among rural women, those in poorer wealth quintiles, women with primary education, those aged 25–34 years, and currently working women. Multivariable logistic regression identified household wealth, region, age group, and employment status as key independent predictors. One-to-one nearest-neighbor PSM (with excellent post-matching balance) showed that exposure to IPV was associated with a 43.8 percentage point higher prevalence of modern contraceptive use (ATT = 0.438, p &lt; 0.01) compared to matched women without IPV exposure. These findings suggest that, in the Malawian context, women experiencing IPV may actively adopt modern contraceptives as a protective strategy to enhance reproductive autonomy. The study underscores the need for integrated interventions that combine gender-based violence prevention with strengthened, confidential family planning services.</p>